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Respiratory Unit 1 > Respiratory Failure > Flashcards

Respiratory Failure Flashcards

1
Q

What is the goal of the respiratory system?

A

The goal of the respiratory system is to provide the body an adequate oxygen supply for cellular metabolism and to remove the body’s major metabolic waste product: carbon dioxide.

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2
Q

What three mechanisms is respiration accomplished by?

A
  1. Ventilation 2. Diffusion 3. Circulation/Perfusion
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3
Q

What is respiratory failure defined as?

A

Impaired gas exchange Normally defined as: PaO2 < 50mmHg Hypoxemia PaCO2 > 50mmHg Hypercarbia

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4
Q

What things lead to hypoxemia? Hypercapnia?

A
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5
Q

What are the classifications of Respiratory failure?

A
  1. Acute 2. Chronic 3. Acute on Chronic
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6
Q

Hypercapnia is associated with what finding?

A

Respiratory acidosis

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7
Q

What are common diseases that lead to hypoxia?

A

conducting airways asthma,

pneumonia, pulmonary emobolism

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8
Q

Explain acute respiratory failure for both hypercapnia and hypoxemia?

A

Acute

Minutes to hours; no compensatory changes

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9
Q

Explain chronic respiratory failure for both hypercapnia and hypoxemia?

A

Hypercapnia Days to months; compensatory mechanisms present are increase pH and increase HCO3

Hypoxemia: Days- months compensatory mechanism present is increase in hemoglobin

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10
Q

What diseases could lead to acute? chronic? and acute on chronic respiratory failure?

A
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11
Q

What are the classifcations of respiratory failure?

A

Type I Hypoxemic PaO2 < 50 at sea level

Type II Hypercapnic +/- Hypoxemic PaCO2 > 45

Other: Type III Perioperative

Type IV Shock

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12
Q

What are the four mechanisms hypoxemic respiratory failure might happen due to?

A

A. Ventilator/Perfusion Inequality (V/Q)

B. Shunt

C. Hypoventilation

D. Diffusion Impairment

*Rarely low FIO2

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13
Q

Findings associated with hypoventilation?

A
  1. Increased PACO2 and PaCO2
  2. Decreased PAO2 and PaO2
  3. Normal P (A-a) O2 gradient when it occurs acutely
  4. PAO2 and PaO2 (but not the hypoventilation) can be corrected by raising FIO2
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14
Q

Findings associated with a shunt?

A
  1. Causes a fall in PaO2
  2. Results in a increased P (A-a) O2 gradient
  3. Responds poorly to increased FIO2
  4. Measure clinical on 100% O2
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15
Q

Findings seen with a Low ventilation/perfusion mismatch?

A
  1. Causes a decreased PaO2 due to low V/Q alveoli
  2. Usually associated with a normal PaCO2
  3. Associated with an increased P (A-a) O2 gradient
  4. Characteristically responds well to small increases in FIO2 5. Completely corrected by 100% oxygen
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16
Q

What findings does a diffusion impairment lead to?

A
  1. Causes a decreased PaO2 and a normal PAO2
  2. Associated with a normal or low PaCO2
  3. Causes an increased P(A-a)O2 gradient
  4. Rarely the sole cause of the hypoxemia
17
Q

Key points of hypoxemia?

A
  1. Only hypoventilationis associated with a normal A-a gradient: P (A-a) O2
  2. Only shunt is not corrected by 100% oxygen
  3. Hypoxemia due to low V/Q ratio responds to small increases in FIO2
18
Q

What is the approach to diagnosing respiratory failure?

A

• History • Symptoms • Physical Exam • Diagnostic Laboratory Investigations • Imaging • ABG analysis A-a gradient • Pulmonary Function Test: Spirometry Lung Volumes Max Inspiratory Pressure (NIF)

19
Q

What symptoms are seen in respiratory failure? what do they reflect?

A

Dyspnea

Tachypnea

Confusion

Stridor

Headache

These reflect the acuity and the underlying cause

20
Q

What to look for on the PE of respiratory failure?

A

Use of accessory muscles of respiration

Retraction of intercostal space (Hoover’s Sign) Cyanosis

Wheeze, Rales, Rhonchi

Asterixis

Papilledema

Coma
Findings reflect the acuity and underlying cause(s)

21
Q

Treatments for Pump failure and for Lung failure to correct respiratory failure?

22
Q

What is the goal of treatment for both types of respiratory failure?

A

Goal: Provide adequate oxygenation to treat underlying disorder Oxygen should always be used to treat hypoxemia

  1. Ensure upper airway potency
  2. Supplemental O2 and ventilator support as indicated
  3. Immediate attention to the underlying cause(s)

Reduce ventilator work load (WOB)

COT: Conventional Oxygen Treatment

HFNC High Flow Nasal Cannula

NIV/NIPV Non-invasive Positive Pressure Ventilation Mechanical Ventilation

ECOM

Medications

Nutritional support

Rehabilitation

23
Q

how does mechanical ventilation help to correct respiratory failure?

24
Q

summary of how to treat respiratory failure?

Respiratory Unit 1 (10 decks)

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